In the proposed project, we will utilize simulation technology to assess a physicians' competence in acute care incidents and their abilities to communicate effectively with fellow team members. In the first specific aim, 150 medical students and interns will be evaluated as they manage 15 different acute care events, using a full-scale electro-mechanical mannequin in a range of simulated medical settings. An expert panel will define a competence standard for each scenario by reviewing a representative sample of participants' performances. These competency-based decisions will then be compared to the raters' analytic scores. Our goal in these procedures is to provide an unambiguous performance standard that can be readily measured and effectively attained by physicians. The competence standard will provide an objective method to identify physicians who do not meet the requisite skill level. In the second specific aim, we will implement a simulation-based methodology to objectively and subjectively measure 50 physicians' communication behaviors as they interact with a nurse in an acute care management setting. In a first analysis, ethnographic measures will include time spent in communication breakdown and the effectiveness of the physician in repairing these breakdowns. In a second analysis, a panel of nurses and physicians will rate the communication skills of each physician and the overall communication effectiveness that occurs during the physician-nurse interaction. By conducting two analyses and including both physician and nurse judges, we can relate the two types of measures and also compare and contrast the impressions of physicians and nurses. Importantly, our assessment will control for a variety of extraneous variables that sometimes plague observational reports. During the course of completing these two specific aims, we will call upon the expertise of a multi-disciplinary team that includes physicians, nurses, and experts in both aural rehabilitation and psychometrics. By the completion of .the project, we will have developed procedures to assess the two primary components of managing acute care events, clinical skills and communication effectiveness, and procedures that will serve as a model for other applications of simulation technology in the field of assessment. In addition, our findings about the performance of a large number of physicians will provide specific directions for future medical training, and will ultimately result in improved patient safety. [unreadable] [unreadable] [unreadable] [unreadable]